Form PTO/SB/96 Statement under 37 CFR 3.73(b)

Patent Processing

PTOSB96

Statement Under 37 CFR 3.73(c) (Individuals And Households)

OMB: 0651-0031

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PTO/SB/96 (11-18)
Approved for use through XX/XX/XXXX. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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STATEMENT UNDER 37 CFR 3.73(b)
Applicant/Patent Owner:
Application No./Patent No.:

Filed/Issue Date:

Titled:

,a
(Name of Assignee)

(Type of Assignee, e.g., corporation, partnership, university, government agency, etc.

states that it is:
1.

the assignee of the entire right, title, and interest in;

2.

an assignee of less than the entire right, title, and interest in
(The extent (by percentage) of its ownership interest is

3.

the assignee of an undivided interest in the entirety of (a complete assignment from one of the joint inventors was made)

%); or

the patent application/patent identified above, by virtue of either:
A.
OR
B.

An assignment from the inventor(s) of the patent application/patent identified above. The assignment was recorded in
the United States Patent and Trademark Office at Reel
, Frame
, or a copy*
is attached.
A chain of title from the inventor(s), of the patent application/patent identified above, to the current assignee as follows:
1. From:

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

2. From:

,

or a copy* is attached.

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

3. From:

,

or a copy* is attached.

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

,

or a copy* is attached.

Additional documents in the chain of title are listed on a supplemental sheet(s).
*As required by 37 CFR 3.73(b)(1)(i), if a copy/copies is/are attached, the documentary evidence of the chain of title from the
original owner to the assignee was, or concurrently is being, submitted for recordation pursuant to 37 CFR 3.11.
[NOTE: A separate copy (i.e., a true copy of the original assignment document(s)) must be submitted to Assignment Division in
accordance with 37 CFR Part 3, to record the assignment in the records of the USPTO. See MPEP 302.]
The undersigned (whose title is supplied below) is authorized to act on behalf of the assignee.
Signature

Printed or Typed Name

Date

Title or Registration Number

This collection of information is required by 37 CFR 3.73(b). The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to
process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 15 minutes to complete, including
gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount of time
you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Administrative Officer, U.S. Patent and Trademark Office, U.S.
Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner
for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with
your submission of the attached form related to a patent application or patent. The United States Patent
and Trademark Office (USPTO) collects this information under authority of 5 CFR 339.205. The
information in this system of records is used to manage all records of applicant including name,
citizenship, residence, post office address and other information pertaining to the applicant's activities in
connection with the invention for which a patent is sought. Statements containing various kinds of
information with respect to inventors who are deceased or incapacitated, or who are unavailable or
unwilling to make application for patent. The information obtain is protected from disclosure to third parties
in accordance with the Privacy Act.
However, routine uses of this information may include disclosure to the following: to law enforcement and
investigation in the event that the system of records indicates a violation or potential violation of law; to a
Federal, state, local, or international agency, in response to its request; to an agency, organization, or
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personnel under contract to the agency; to a court for adjudication and litigation; to the Department of
Justice for Freedom of Information Act (FOIA) assistance; to members of congress working on behalf of
an individual; to the Office of Personnel Management (OPM) for personnel research purposes; to National
Archives and Records Administration for inspection of records; and to the Office of Management and
Budget (OMB)for legislative coordination and clearance. Failure to provide any part of the requested
information may result in an inability to process requests for access and information. The applicable
Privacy Act System of Records Notice for this information is COMMERCE/PAT-TM-7 Patent Application
Files, available at Federal Register /Vol. 78, No. 61 / Friday, March 29, 2013 /Notices 19243. https://
www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf


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